Skin Lesion and Scar Revision
TREATMENT OF SKIN LESIONS, MOLES, CYSTS, LIPOMAS, SKIN TAGS OR SCAR REVISION
Skin lesions can be treated by excision, laser, photo dynamic therapy (PDT), and in some cases topical creams. It is important to have a referral from your GP to the Plastic Surgeon for assessment and treatment of these conditions. During the assessment, your surgeon will assess if laser, PDT or topical creams will help the condition. If not then surgical excision may be the best option for removal of the lesion.
Laser can be performed on some areas to remove the superficial lesion or sun damaged skin cells, and is usually performed in a theatre using local anaesthetic with sedation (LAWS). The aftercare and downtime varies on the extent of laser being performed.
PDT can also be used with some skin lesions and involves the application of products to the lesion that remain on for a few hours. Once the designated time has been reached then the area being treated will also be exposed to a photo dynamic light to activate the product. The area being treated will progressively change over a few weeks in colour, with scab formation and flaking off of the scab.
Skin lesions such as cancers or benign lumps, cysts, mole removal, skin tag removal or scars are generally removed under local anaesthetic, local with sedation, or general anaesthetic as a day surgery procedure. If the lesion/scar being removed requires extensive surgery or your health is of poor quality you may be required to stay over night in hospital.
Each lesion or scar is excised in the best possible orientation (direction), and sutured using plastic surgery techniques and sutures.
Some lesions and scar revision will require sutures which need to be removed, or may use dissolving sutures which remain in place and dissolve over time.
There are different types of excisions which may be needed to excise your skin lesion or scar revision:
DIRECT CLOSURE: The lesion/scar is usually removed in an oval shape and the two sides directly joined together and closed with either sutures, dissolving sutures, or staples. This will be done under local (LA) or local with sedation (LAWS).
FLAP REPAIR: This will be used when skin adjacent to the excision site is needed to cover the area the lesion/scar was removed from. This is used to prevent pulling and puckering of the surrounding area. This will usually leave a V, Z or T shaped scar. This will be done under local (LA) or local with sedation (LAWS).
SPLIT SKIN GRAFT (SSG): Skin usually from the thigh/leg is taken to cover the excision site. This is used when the area being excised is too large to have a direct closure or flap repair. A dressing will be applied to the donor site and will heal on its own. The cosmetic result will not usually be as good as direct closure or flap repair. A Split Skin Graft will be done under local (LA), local with sedation (LAWS), or general anaesthetic (GA).
FULL THICKNESS GRAFT (FTG): Skin usually from behind the ear is taken to cover the excised site. This is used when a thicker piece of skin is required to cover the excised site and a direct closure, flap or SSG is not appropriate. A dressing will usually be tied over the graft. The graft may not be a perfect colour match to the area it is being moved too. This will be done under local (LA), local with sedation (LAWS), or general anaesthetic (GA)
LASER: This is used to treat superficial skin lesions that are usually high in number. No dressing is needed and an antibiotic ointment is applied to the treated area three times a day for two weeks. This will be done under a general anaesthetic (GA).
SHAVE: Occasionally your surgeon may be able to shave lesions such as skin tags when no excision is needed. There is generally no need for dressings and antibiotic ointment is applied to the shaved sites. This will be done under local (LA), or local with sedation (LAWS).
Removal of a skin lesion or a scar revision may require different types of anaesthetic. The types of anaesthetic are listed below:
GENERAL ANAESTHETIC (GA): This usually involves an injection into a vein, and you will be in a deep sleep during the procedure. If your procedure is on the Gold Coast, you will need to have nothing to eat or drink (including water) 6 hours before your procedure. If you are having surgery in Ballina you are to have nothing to eat 6 hours prior and nothing to drink (including water) 4 hours prior to your surgery. You are not allowed to drive and will need to have someone assist you home. If you need to take medication during the 6 hour fasting period please check with your physician if this can be done prior to the 6 hour fasting period or after surgery.
LOCAL ANAESTHETIC WITH SEDATION (LAWS): This usually involves an injection into a vein, and you will be in a light sleep during the procedure. If your procedure is on the Gold Coast, you will need to have nothing to eat or drink (including water) 6 hours before your procedure. If you are having surgery in Ballina you are to have nothing to eat 6 hours prior and nothing to drink (including water) 4 hours prior to your surgery. You are not allowed to drive and will need to have someone assist you home. If you need to take medication during the 6 hour fasting period please check with your physician if this can be done prior to the 6 hour fasting period or after surgery.
LOCAL ANAESTHETIC (LA): This involves a needle to the area to sedate the area being excised. You are awake during the procedure. You can eat and drink as normal.
You may experience side effects from the anaesthetic. These include nausea, light-headedness, constipation or a skin rash.
SPECIFIC SURGICAL RISKS
Modern surgery is safe. There is, however, no such thing as “risk free” surgery. The important thing is to understand any potential risks and minimise their occurrence.
INCOMPLETE REMOVAL: Some skin lesions have invisible margins or edges. Cysts may be very ill defined. If large “margins” are excised around the lesion, the scar will be larger and the repair more difficult. Your surgeon will use their best judgment in removing the correct amount of skin around the lesion or cyst. Occasionally, the pathology report will indicate that a second procedure is necessary to “get it all”.
SCAR: Even if the best plastic surgery techniques are used, the scar may heal thicker or wider (keloid) than desired. Scars generally fade over several months or years, but may always remain visible. Occasionally a secondary revision surgery may be needed to obtain the desired result. The individual body will react differently to healing and how well it heals correlates directly to the individuals tissues.
INFECTION: Your wound may become infected needing treatment with antibiotics. If this occurs your wound may become inflamed and discharge noticeable.
PAINFUL SCAR: Once healed, most scars are painless. Scars on fingertips, bottom of feet, lips, etc. may remain tender for longer periods of time.
WOUND BREAK DOWN: A graft may not take and may break down. If this occurs antibiotics or a secondary procedure may be needed.
SKIN CANCER: Most skin lesions are not malignant and are moles (nevi), cysts, skin tags or early pre-malignant changes. If pathology shows a basal cell or squamous cell skin cancer, COMPLETE EXCISION is usually the only surgical treatment needed. Malignant melanoma is the most aggressive and dangerous skin cancer and may require further surgery to obtain a greater margin.
RECURRENCE AND SPREAD OF SKIN CANCERS: Skin cancers can recur following excision and require secondary treatment. Very malignant skin cancers (usually melanomas) may spread (metastasise) to other areas or organs in the body, and require systematic treatment and even prove fatal.
ALTERNATIVES: Obviously benign lesions can be left untreated with very little risk. Suspicious or proven skin cancers can also be treated with electro-desiccation (cautery) or X-ray therapy. Treatment of the skin with anti-cancer creams, peels or laser resurfacing may be appropriate for early or very superficial lesions. If a non surgical treatment is an option then this will be discussed with you.
AS YOU HEAL INFORMATION
SWELLING: Most of the swelling is gone within a month, but all the swelling usually takes about 6 months to completely disappear.
SCAR REDNESS: It may take 6 – 18 months for the scar to fade.
TENDERNESS: All discomfort is usually gone within a month.
NUMBNESS: Small areas of numbness around the incision (if present) usually clears in 2 to 3 months.
ITCHINESS: You may experience itchiness during the healing process, but this will settle once the healing is complete.
PRE OPERATIVE INSTRUCTIONS
MEDICATION: Certain over the counter products and prescription medicines can cause complications before and after surgery. They can reduce the ability of your blood to clot and could increase your tendency to bleed during and after surgery. Do not take any medication containing or related to aspirin 10 days prior to your procedure and three days post operatively unless otherwise advised by your surgeon. Please check with your surgeon whether you need to cease medication prior to your procedure. Also avoid Vitamin E supplements, fish oil and red wine. Stop all herbal medications before surgery. The most common herbs used are Echinacea, Ephedra, Garlic, Ginseng, Ginkogo, Kava, St. John’s Wort, and Valerian. They may adversely effect anaesthetic drugs, prolong bleeding and impair healing after surgery. Please consult your physician before ceasing any medication. Paracetamol ie. Panadol is fine to take.
WASHING: Wash the evening prior to surgery and the day of surgery paying particular attention to the area to be operated on. This decreases the bacterial count and should decrease the risks of infection.
FASTING: If you are having a General Anaesthetic (GA) or Local anaesthetic with Sedation (LAWS) you should have nothing to eat or drink for six hours prior to your operation. Local Anaesthetic (LA) only surgery requires no fasting.
POST OPERATIVE INSTRUCTIONS
DRESSING: Your surgeon and The Layt Clinic staff will advise you how on long they wish the dressing to be left in place. Once the dressing is removed keep the incision and surrounding skin clean with luke warm water. Getting the incision wet does not harm, and pat your incision dry.
PAIN: Usually very minimal and requires no more than Panadol for control.
AVOID INJURIES: Direct injury, stretch and tension to the new wound can break the sutures and pull the wound edges apart. Use common sense when planning activities.
BLEEDING: If excessive bleeding occurs, apply direct pressure for 10 – 20 minutes. If control is achieved, no other immediate treatment is necessary. If bleeding persists, call The Layt Clinic.
ICE PACKS: Ice can relieve discomfort and reduce swelling. Intermittent application of an ice pack, a soft pack of frozen peas, etc, can be helpful.
SUTURES/STAPLES: Sutures are usually removed in 5 – 7 days. Staples will be removed in 9 – 11 days, and if internal dissolving sutures are used these stay in place and a dressing applied which will be changed in 7 – 10 days post operatively. You may be required to apply antibiotic ointment to the area. Do not get your incision site wet while you have sutures or staples in place.
For further information on managing scarring, please visit the SCAR MANAGEMENT page.
For further information smoking and surgery, please visit the SMOKING AND SURGERY page.